After dental school, I completed my residency at a Veterans Affairs Hospital. During that time, I did not see one pregnant woman during my residency. For a while, I forgot pregnant women existed in the dental practice. After moving on to private practice, I quickly realized I had pregnant patients, and they had a lot of questions and held misconceptions. So I did my research, I read the studies and articles, and I put together a one-page synopsis for my patients (click here to view).
Like anything else in the medical field, there are many differing opinions, ideas, and theories regarding pregnancy, and specifically, dental treatment during pregnancy. Much of the old dogma involving pregnant women and dentistry has been shown to be false, yet many practitioners, dentists and physicians alike, continue to abide by them. I’d like to take this opportunity to review some of the issues surrounding dental treatment and oral health during pregnancy to clear up some of the confusion. Let’s begin…
Your Oral Health During Pregnancy
Pregnancy brings upon many changes in the body’s hormones, affecting multiple systems including the oral cavity. Pregnancy gingivitis is probably the most common change that affects the mouth. Gingivitis simply means “inflammation of the gums.” Fortunately, it is reversible with proper home care and regular dental visits. If left untreated, it may progress to periodontitis, which involves loss of gum tissue and bone surrounding the teeth. This is NOT reversible. Approximately 40% of pregnant women have some form of periodontal disease (which includes gingivitis). Some studies have shown an association between periodontal disease and pre-term birth. So now we know the importance of maintaining optimal oral health during pregnancy. Fortunately, treatment of periodontal disease during pregnancy is not associated with any adverse maternal or birth outcomes. In other words, it’s safe for you and your baby to undergo dental cleanings during pregnancy.1
X-Rays- Safe During Pregnancy?
I think it’s safe to say that we want to limit exposure to all sources of radiation during pregnancy. It was previously thought that pregnant women should not have any x-rays taken, however, that thinking has changed. Due to the decreased amount of radiation from digital x-rays, they are considered to be safe during pregnancy, provided proper shielding1 (the “lead” apron- most don’t have actual lead anymore). Since dental treatment is safe during pregnancy (as I will get to next), it is better to catch a problem when it’s relatively minor, rather than delay x-rays and treatment until the problem becomes bigger, causing pain and/or infection. Even with this information, many of my pregnant patients refuse dental x-rays. If you have a healthy dental history, I would agree that we can postpone the x-rays until postpartum.
My Doctor Told Me “No Epinephrine”
Most local anesthetics used in dentistry such as Lidocaine and Septocaine (by far the two most common dental anesthetics) contain epinephrine. The purpose of the epinephrine is to constrict the blood vessels in the area of injection. It makes the anesthetic more effective and longer lasting, which reduces the chance of discomfort during a procedure.
The body makes epinephrine naturally as well- some people know it better as adrenaline. When a car cuts you off in traffic and you get tense, your body is releasing epinephrine. It is natural and at low levels perfectly safe. Therefore, not surprisingly, it’s safe for your dentist to use during pregnancy as well.1 The amount of epinephrine in dental anesthetics is very, very low. And we are not injecting into major vessels so that the effect is mainly local, not generalized. Your body would most likely release more epinephrine if we started drilling on a tooth without being properly numb than you would get from the injection alone.
In a recent study published by the American Dental Association, the use of dental anesthetics, as well as dental treatment, during pregnancy did not present a major risk to the baby. In this study, there were no differences in the rate of miscarriages, gestational age at delivery, or birth weight when comparing those who received dental treatment with local anesthetics with epinephrine versus those who were not exposed. The most common dental treatments were root canals, tooth extraction, and tooth restoration (fillings, crowns, bridges).2
Here is the bottom line- dental treatment is safe during pregnancy and you run the risk of more serious consequences by avoiding necessary dental treatment during this time. Most importantly, maintaining excellent oral hygiene practices is the best way to avoid dental issues. Brush twice daily, floss once daily, and visit your dentist twice a year.
[ 1 ] Oral health care during pregnancy and throughout life. Committee Opinion No. 569. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 122:417-22.
[ 2 ] Pregnancy outcomes after in utero exposure to local anesthetics as part of dental treatment. Hagai, Aharon, et al. The Journal of the American Dental Association, Volume 146, Issue 8, 572-580.